Category: Limb Restoration Rehabilitation; Quality Improvement and Implementation Science
Objective : To identify the strongest predictors of rehabilitation length of stay (LOS) and successful prosthetic fitting for lower limb amputees.
Design : Retrospective analysis of prospectively collected data.
Setting : Rehabilitation hospital.
Participants (or Animals, Specimens, Cadavers) : Consecutive lower limb amputees admitted for prosthetic fitting (N = 103; mean age 65.27 ± 10.59 years).
Interventions : Not applicable.
Main Outcome Measure(s) : Predictor variables included the Lower Limb Amputee Measurement Scale (LLAMS), which is a 31-question tool to predict LOS with indicators in Medical, Cognitive, Social, Physical, Activities of Daily Living (ADL), and Other subsections; admission Functional Independence Measure (FIM); age; sex; level of amputation (transtibial or transfemoral); and time from surgery to admission. LOS was measured as days from admission to discharge. Successful fitting was defined as ability to use a prosthesis on discharge.
The LLAMS, admission FIM, and level of amputation significantly predicted LOS (p < 0.001, R squared = 0.361). Age, sex, and time from surgery did not significantly predict LOS. 20.6% of the variance in LOS was explained by the LLAMS. Only LLAMS significantly (p = 0.032) predicted successful prosthetic fitting. Within the LLAMS, 4 of the 31 indicators (1 Cognitive, 1 Social, 2 Other) significantly predicted LOS and four (1 Cognitive, 2 Physical, 1 ADL) significantly predicted successful fitting. A revised LLAMS, including the strongest predictors, increased the r squared of the models.
Conclusions : The LLAMS, level of amputation, and admission FIM can be used to predict LOS in lower limb amputees admitted for prosthetic fitting. Within the LLAMS, history of cognitive impairment/psychiatric illness, “gut feeling”, and living alone were the strongest predictors of increased LOS; Physical and ADL indicators were the strongest predictors of successful fitting. Removing insignificant indicators increases the predictive ability of the LLAMS.
Michael Chislett– Student, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador
Michelle Ploughman– Associate professor, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador
Jason McCarthy– Associate Professor of Medicine (Physical Medicine & Rehabilitation), Memorial University of Newfoundland, St. John's, Newfoundland and Labrador